Is Russia entering another dark age of psychiatry?

Recent Western pressreports have indicated that the Russian psychiatric system might be experiencing a return to the ‘bad old days’ when it was used in part to suppress political dissidents.

President of the human-rights focused psychiatrists’ organisation the Independent Psychiatric Association of Russia (IPA), Dr Yuri Savenko, has kindly agreed to talk to Mind Hacks about the current situation.

In 1983 the main Russian psychiatric association, the All-Union Society of Psychiatrists and Narcologists resigned from the World Psychiatric Association before it could be expelled.

While the the Society claimed it was being ‘slandered’, evidence was presented to the WPA of high-profile dissidents being sent to psychiatric hospitals on the basis of their political beliefs.

At the end of the 1980s, the Independent Psychiatric Association of Russia was formed by psychiatrists and health professionals wanting to expose abuses in the system and provide an alternative to the existing professional organisation. They gained independent admission to the WPA in 1989.

As the Soviet Union became more open in the period of Glasnost reforms, a delegation of American psychiatrists were invited to assess Soviet psychiatric facilities in 1989 and reported significant evidence [pdf] that political dissidents had been subjected to “excessive and inappropriate” detainment and treatment.

This spurred a reform in Russian psychiatry and after much debate the All-Union Society of Psychiatrists and Narcologists were re-admitted to the WPA, leading to new hopes for a renewed Russian psychiatric system and, indeed, further revelations about past-abuses.

However, recent press reports have suggested that both people who fall foul of criminals and high profile dissidents have been subject to ‘punitive psychiatry’, suggesting a return to the dark days of Soviet psychiatry and ‘psikhuska‘ hospitals.

The case of journalist Larisa Arap has been of particular concern recently, after she was admitted to psychiatric hospital and forcibly medicated after she wrote about alleged abuses in the same clinic only weeks earlier. Her friends and relatives protested that she showed no evidence of mental illness.

IPA President and psychiatrist Dr Yuri Savenko agreed to give his views on the current situation in Russia.

Note: Dr Yavenko answered the questions in Russian which were translated into English by an IPA member. The translation is left unaltered, but the original Russian version is available here.

What evidence is there that people are currently being subjected to “punitive psychiatry” in Russia?

Such tendency does exist and the Independent Psychiatric Association of Russia has been working on this issue for the past 18 years. Since 1995, regardless of the protest of Russian psychiatric society, psychiatry became a tool to close religious organizations. This method quickly became a routine and led to corruption as well as the loss of independent judicial powers.

From 1997, members of NPA were also not allowed to take any part in the forensic psychiatric examination commission of the Serbski Center, even though it was never officially ruled. In addition, the Serbski Center legitimized their actions and this evolved into a total state control of the forensic psychiatric evaluation. Therefore, no outside party could be a part of the expertise commission.

With the introduction of the new “extremism” law, which is considered as rather vague, we find ourselves retreating back to the Soviet times. The law is very broad and any form of criticism against the state or public institutions may be considered as “extremism”. It’s just the same situation as we had in soviet time with the former law Article of “slandering of the soviet powers” and cases handled by the authority. Therefore, it is not surprising that over the years, the number of unsatisfied Russian citizens who had once crossed paths with the authority, has soared.

Many of them are sent to forensic psychiatric evaluation. They often are members of human rights groups and civic society organizations. Although these members are usually qualified by psychiatrists adequately, they would not have been examined by psychiatrists if not for the distaste for the article mentioned above. In addition, we have also been confronted with an abuse of legal regulations, specifically pertaining to the widening of the medical term, “danger or threat to the public.”

With respect to the cases of Larissa Arap from Murmansk, Olga Popova in Moscow, Andrei Novinka from Rybinska and others, people were hospitalized under the pretense of being a “danger to the public,” when in fact, not one of these cases showed any signs aggression, danger or threat. This example shows that people with mental disorders are the most vulnerable group of population; they become the first victims of politization of society and the first indicators of critical level of such politization.

What reasons might people be subject to unjustified psychiatric treatment?

This is the most convenient way to make opposition keep silence, to intimidate it, more over that there is unforgotten experience of such actions. The newly formulated articles of the laws of “extreme measure” and “maltreatment of people of different ethnicity and race” is a continuation of the old system in the Soviet times. The first victims are critics of authority, public protesters, people who often apply to court, etc.

Newspaper reports have suggested that some of the alleged cases have been politically motivated. Is there evidence of systematic political influence on the psychiatric system or on individual clinicians?

Everything in politically oriented society takes on political sound, especially ‚Äì as it was in the case of Larisa Arap ‚Äì when it draws the attention of international society. Any criticism of the state power and any grafts of “orange opposition” are considered as political danger.

This will then have an effect on the psychiatric services and the work of doctors. The professional public is frightened by the authoritative atmosphere in the country and it is difficult to find a professional willing to stand in the opposition of the powers.

What action can be taken against clinicians who abuse their position?

Theoretically, professional society can express censure on them, they can be deprived of medical diploma or found themselves under criminal prosecution, but in the end, doctors generally tend to go unpunished

What needs to be done to improve Russian psychiatry?

Other democratic countries could play an important role in developing proper use of psychiatry in Russia under the conditions that:

1) Russia must adhere to the international conventions and recommendations on psychiatric health and Russia‚Äôs actions must be supervised under a special commission

2) It’s necessary to demonstrate to the main supporters of punitive psychiatry in Russia, first of all, administration of the Serbski Center of Social and Forensic Psychiatry inadmissibility of their position, to force them to make appropriate statements

3) All Russian psychiatric organizations must stress on maintaining equal relationship with one another

What are the positive development in the Russian mental health system?

Positive changes in Russian mental health system consist of:

1) The adoption of the law: On psychiatric care and guarantees of citizens’ rights in its provision.

2) Negotiating a separation from the universal psychiatry

3) The formation of a human rights oriented psychiatric organization, The Independent Psychiatric Association of Russia (the member of he World Psychiatric Association since 1989).

4) There are a greater number of medical and psychotherapeutic resources available to improve the rehabilitation of the mentally ill.

UPDATE: I emailed Dr. Valery Krasnov, President of Russian Society of Psychiatrists, to request a commentary on this article but received no response.

The trouble with psychiatry is that definitions of mental illness, even in the US, are generated by experts and purely behavioral. It is very easy to subvert this kind of process for political, social and financial purposes.
The story of homosexuality in the DSM is a prime example of this process at work. Since there is a bias of assuming mind=computer here, I’ll recall that Alan Turing was deemed a security risk and forcibly treated for his homosexuality with estrogen injections. He took his life shortly thereafter.
Kutchins and Kirk provide further topics of controversy regarding the process of deciding diagnostic criteria in their book “Making Us Crazy”. (The book is far less inflammatory than the title suggests.)
An philosophical analysis of the current classification system and the difficulties in producing a valid one, are discussed by Rachel Cooper in her book “Classifying Madness”. Philosophical should not be
read as speculative in the previous sentence. The book is a valid exercise in applied philosophy of science.
Given the vulnerability to manipulation, it should not come as a surprise the the Soviets came up with sluggishly-progressing schizophrenia as diagnosis for political dissidents. Or that the PRC still has its own manual of mental disorders (CCMD-3), which include a disorder attributed to the practice of Qigong, and conveniently used to label Falun Gong practitioners are mentally ill. Whether Qigong has any merits I won’t debate here, but suffice to say that any religious beliefs qualify as delusion, thus phychosis, if the cultural aspect is ignored. Freud for instance did not consider the exception
valid. A discussion is provided by Pierre JM in “Faith or delusion? At the crossroads of religion and psychosis.” (PMID: 15990520)
A more recent controversy is that of childhood bipolar disorder. Not yet in the DSM, but given enough political pressure from the right groups, I’ll eat my socks it will be in the next edition.